Update on talar fracture patterns: a large level I trauma center study.

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Abstract

[Indexed for MEDLINE] 17. Orthop Surg. 2024 May;16(5):1196-1206. doi: 10.1111/os.14033. Epub 2024 Mar 14. Three-dimensional Mapping Analysis of Talus Fractures and Demonstration of Different Surgical Approaches for Talus Fractures. Wang R(1)(2), You G(1), Yin S(1), Jiang S(3), Wang H(4), Shi H(5)(6)(7), Zhang L(5)(6)(7). Author information: (1)School of Physical Education, Southwest Medical University, Luzhou, China. (2)Department of Rehabilitation, Yibin Integrated Traditional Chinese and Western Medicine Hospital, Yibin, China. (3)School of Clinical Medicine, Southwest Medical University, Luzhou, China. (4)Department of Medical Imaging, Yibin Integrated Traditional Chinese and Western Medicine Hospital, Yibin, China. (5)Department of Orthopaedics, The Affiliated Traditional Chinese Medicine Hospital, Southwest Medical University, Luzhou, China. (6)Center for Orthopaedic Diseases Research, The Affiliated Traditional Chinese Medicine Hospital, Southwest Medical University, Luzhou, China. (7)Luzhou Key Laboratory of Orthopedic Disorders, Luzhou, China. OBJECTIVE: The talus is an important component in the ankle, and its treatment after injury is crucial. However, complications and adverse events due to incomplete traditional classifications may still occur, and these classifications fail to analyze the patterns and distribution of fractures from a three-dimensional perspective. Therefore, in this study, we aimed to analyze the location and distribution of fracture lines in different types of talus fractures using three-dimensional (3D) and heat mapping techniques. Additionally, we aimed to determine the surface area of the talus that can be utilized for different approaches of internal fixation, aiding in the planning of surgical procedures. METHODS: We retrospectively analyzed data from CT scans from 126 patients diagnosed with talus fractures at our two hospitals. We extracted the CT data of a healthy adult and created a standard talus model. We performed 3D reconstruction using patients' CT images and superimposed the fracture model onto the standard model for drawing fracture lines. Subsequently, we converted the fracture lines into a heat map for visualization. Additionally, we measured 20 specimens to determine the boundary for various ligaments attached to the talus. We determined the surface area of the talus available for different surgical approaches by integrating the boundary data with previously reported data on area of exposure. RESULTS: Without considering the displacement distance of the fracture, fracture types were classified as follows, by combining Hawkins and Sneppen classifications: talar neck, 41.3%; posterior talar tubercle, 22.2%; body for the talus and comminuted, 17.5%; lateral talar tubercle, 11.9%; and talar head, 7.1%. We established fracture line and heat maps using this classification. Additionally, we demonstrated the available area for anteromedial, anterolateral, posteromedial, posterolateral, and medial malleolus osteotomy and Chaput osteotomy approaches. CONCLUSION: Fracture line and heat map analyses can aid surgeons in planning a single or combined surgical approach for the reduction and internal fixation of talus fractures. Demonstrating the different surgical approaches can help surgeons choose the most effective technique for individual cases. © 2024 The Authors. Orthopaedic Surgery published by Tianjin Hospital and John Wiley & Sons Australia, Ltd. DOI: 10.1111/os.14033 PMCID: PMC11062851